Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi

doi:10.1016/j.ajur.2019.07.002

Asian Journal of Urology, 2020, 7 (2): 87-93 doi: 10.1016/j.ajur.2019.07.002

Review

Current Issue | Archive | Adv Search

Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi

lIlan Klein(

),Jorge Gutiérrez-Aceves

Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA

Abstract
Related Citation (12)

Download:

HTML

PDF (302KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Staghorn calculi present a particular and challenging entity of stone morphology. Treatment is associated with lower stone-free rates and higher complication rates compared to non-staghorn stones. In this review we looked for the most relevant data on preoperative imaging and access planning to help decision making for percutaneous surgery with this complex condition.
Methods: We conducted a PubMed search of publications in the past 2 decades that include relevant information on the planning for management of staghorn stones. Non-contrast computerized tomography (NCCT) is indeed the standard imaging tool for percutaneous nephrolithotomy (PCNL); additional tools such as three-dimensional computed tomography (CT) reconstruction of the staghorn calculus may help plan access in complex cases. Ultrasound guided percutaneous access may be considered for staghorn stones when planning upper pole access in kidney malposition or complex intrarenal anatomy or with complex body habitus. Wideband doppler ultrasound and real-time virtual sonography can assist. New technologies to improve kidney access such as Uro Dyna-CT or electromagnetic sensor have been reported, but have not shown utilization in staghorn cases. Staghorn morphometry-based prediction algorithms may predict the number of tract(s) and stage(s) for PCNL monotherapy. Lower pole access can be equally effective as upper pole when planning for staghorn and complex stones, with significantly less complications rate; Stone-Tract length-Obstruction-Number of involved calyces-Essence of stone density (STONE) nephrolithometry seems to be the best system to predict outcomes of PCNL in staghorn cases. There is a growing trend of endoscopic combined intrarenal surgery (ECIRS) in concordance with PCNL to treat larger stones. Conservative management of staghorn calculi is an undesired option, but can be an alternative for a carefully selected group of high-risk patients.
Conclusion: Staghorn stones may lead to deterioration of renal function and life-threatening urosepsis. This entity should be managed aggressively with planning ahead for surgery using the different tools available as the cornerstone for a successful outcome.

Key words： Staghorn stone Preoperative planning Imaging Kidney access

Received: 28 January 2019 Available online: 06 July 2019

Corresponding Authors: lIlan Klein E-mail: Ilan.shorts@gmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	lIlan Klein
	Jorge Gutiérrez-Aceves

TRENDMD:

Cite this article:

lIlan Klein,Jorge Gutiérrez-Aceves. Preoperative imaging in staghorn calculi, planning and decision making in management of staghorn calculi[J]. Asian Journal of Urology, 2020, 7(2): 87-93.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2019.07.002 OR http://www.ajurology.com/EN/Y2020/V7/I2/87

[1]	K.A. Healy K. Ogan. , Pathophysiology and management of infectious staghorn calculi. Urol Clin, 34(2007), pp. 363-374.
[2]	D. Assimos, A. Krambeck, N.L. Miller, M. Monga, M.H. Murad, C.P. Nelson , et al. Surgical management of stones: American urological association/endourological society guideline, PART I&II. J Urol, 196(2016), pp. 1153-1169.
[3]	M. Desai, A. De Lisa, B. Turna, J. Rioja, H. Walfridsson, A. D'Addessi, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones. J Endourol, 25(2011), pp. 1263-1268.
[4]	K.R. Ghani, U. Patel, K. Anson. Computed tomography for percutaneous renal access. J Endourol, 23(2009), pp. 1633-1639.
[5]	J. Hubert, A. Blum, L. Cormier, M. Claudon, D. Regent, P. Mangin. Three-dimensional CT-scan reconstruction of renal calculi. A new tool for mapping-out staghorn calculi and follow-up of radiolucent stones. Eur Urol, 31(1997), pp. 297-301.
[6]	H. Li, Y. Chen, C. Liu, B. Li, K. Xu, S. Bao. Construction of a three-dimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. Urol Clin, 33(2006), pp. 353-364.
[7]	N. Thiruchelvam, H. Mostafid, G. Ubhayakar. Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting. BJU Int, 95(2005), pp. 1280-1284.
[8]	S. Mishra, R.B. Sabnis, M. Desai. Staghorn morphometry: a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy. J Endourol, 26(2012), pp. 6-14.
[9]	J. de la Rosette, D. Assimos, M. Desai, J. Gutierrez, J. Lingeman, R. Scarpa, et al. The Clinical Research Office of the Endourological Society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol, 25(2011), pp. 11-17.
[10]	N.R. Netto Jr., J. Ikonomidis, O. Ikari, J.A. Claro. Comparative study of percutaneous access for staghorn calculi. Urology, 65(2005), pp. 659-662.
[11]	C. Wong, R.J. Leveillee. Single upper-pole percutaneous access for treatment of > or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary? J Endourol, 16(2002), pp. 477-481.
[12]	Tefekli, T. Esen P.J. Olbert, D. Tolley, R.B. Nadler, Y.H. Sun, , et al. Isolated upper pole access in percutaneous nephrolithotomy: a large-scale analysis from the CROES percutaneous nephrolithotomy global study. J Urol, 189(2013), pp. 568-573.
[13]	K.A. Blum, E. Parkhomenko, J. Thai, T. Tran, M. Gupta. A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy. World J Urol, 36(2018), pp. 1461-1467.
[14]	A.P. Ganpule, M. Desai. Management of the staghorn calculus: multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol, 18(2008), pp. 220-223.
[15]	T. Akman, E. Sari, M. Binbay, E. Yuruk, A. Tepeler, M. Kaba , et al. Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. J Endourol, 24(2010), pp. 955-960.
[16]	Turna, O. Nazli, S. Demiryoguran, R. Mammadov, C. Cal. CalPercutaneous nephrolithotomy: variables that influence hemorrhage. Urology, 69(2007), pp. 603-607.
[17]	Gorbachinsky, K. Wood, M. Colaco, S. Hemal, J. Mettu, M. Mirzazadeh, et al. Evaluation of renal function after percutaneous nephrolithotomy—does the number of percutaneous access tracts matter? J Urol, 196(2016), pp. 131-136.
[18]	M. Singla, A. Srivastava, R. Kapoor, N. Gupta, M.S. Ansari, D. Dubey , et al. Aggressive approach to staghorn calculi-safety and efficacy of multiple tracts percutaneous nephrolithotomy. Urology, 71(2008), pp. 1039-1042.
[19]	S. Andonian, C.M. Scoffone, M.K. Louie, A.J. Gross, M. Grabe, F.P. Daels , et al. Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol, 27(2013), pp. 24-28.
[20]	Q. Liu, L. Zhou, X. Cai, T. Jin, K. Wang. Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis, 45(2017), pp. 481-487.
[21]	M. Usawachintachit, D.T. Tzou, W. Hu, J. Li, T. Chi. X-ray-free ultrasound-guided percutaneous nephrolithotomy: how to select the right patient? Urology, 100(2017), pp. 38-44.
[22]	T. Inoue, H. Kinoshita, S. Okada, S. Hamamoto, M. Taguchi, T. Murota , et al. Wideband Doppler ultrasound-guided mini-endoscopic combined intrarenal surgery as an effective and safe procedure for management of large renal stones: a preliminary report. Urology, 95(2016), pp. 60-66.
[23]	Lima, P.L. Rodrigues, P. Mota, N. Carvalho, E. Dias, J. Correia-Pinto, et al. Ureteroscopy-assisted percutaneous kidney access made easy: first clinical experience with a novel navigation system using electromagnetic guidance (IDEAL Stage 1) . Eur Urol, 72(2017), pp. 610-616.
[24]	J. Rassweiler, M.C. Rassweiler, J. Klein. New technology in ureteroscopy and percutaneous nephrolithotomy. Curr Opin Urol, 26(2016), pp. 95-106.
[25]	M. Ritter, M.C. Rassweiler, A. H?cker, M.S. Michel. Laser-guided percutaneous kidney access with the Uro Dyna-CT: first experience of three-dimensional puncture planning with an ex vivo model. World J Urol, 31(2013), pp. 1147-1151.
[26]	S. Hamamoto, R. Unno, K. Taguchi, R. Ando, T. Hamakawa, T. Naiki , et al. A new navigation system of renal puncture for endoscopic combined intrarenal surgery: real-time virtual sonography-guided renal access. Urology, 109(2017), pp. 44-50.
[27]	Yuan, Y. Liu, H. Rao, T. Cheng, Z. Sun, Y. Wang, et al. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol, 30(2016), pp. 754-763.
[28]	Astroza, M. Lipkin, A. Neisius, G. Preminger, M. De Sio, H. Sodha, et al. Effect of supine vs. prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the clinical research office of the endourology society study. Urology, 82(2013), pp. 1240-1244.
[29]	M.?. G?kce, A. Ibi?, A. Sanc?, A. Ak?nc?, U. Ba?c?, E.A. A?ao?lu , et al. Comparison of supine and prone positions for percutaneous nephrolithotomy in treatment of staghorn stones. Urolithiasis, 45(2017), pp. 603-608.
[30]	C.M. Scoffone, C.M. Cracco, M. Cossu, S. Grande, M. Poggio, R.M. Scarpa. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol, 54(2008), pp. 1393-1403.
[31]	J.K. Li, J.Y. Teoh, C.F. Ng. Updates in endourological management of urolithiasis. Int J Urol, 26(2019), pp. 172-183.
[32]	K. Thomas, N.C. Smith, N. Hegarty, J.M. Glass. The Guy's stone score—grading the complexity of percutaneous nephrolithotomy procedures. Urology, 78(2011), pp. 277-281.
[33]	Smith, T.D. Averch, K. Shahrour, D. Opondo, F.P. Daels, G. Labate, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol, 190(2013), pp. 149-156.
[34]	Z. Okhunov, J.I. Friedlander, A.K. George, B.D. Duty, D.M. Moreira, A.K. Srinivasan , et al. S.T.O.N.E nephrolithometry: Novel surgical classification system for kidney calculi. . Urology, 81(2013), pp. 1154-1159.
[35]	F.C. Vicentini, G.S. Marchini, E. Mazzucchi, J.F. Claro, M. Srougi. Utility of the Guy's stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology, 83(2014), pp. 1248-1253.
[36]	Akhavein, C. Henriksen, J. Syed, V.G. Bird. Prediction of single procedure success rate using S.T.O.N.E. nephrolithometry surgical classification system with strict criteria for surgical outcome. Urology, 85(2015), pp. 69-73.
[37]	S. Sfoungaristos, O.N. Gofrit, D. Pode, E.H. Landau, M. Duvdevani. Percutaneous nephrolithotomy for staghorn stones: which nomogram can better predict postoperative outcomes? World J Urol, 34(2016), pp. 1163-1168.
[38]	S.W. Choi, W.J. Bae, U.S. Ha, S.H. Hong, J.Y. Lee, S.W. Kim , et al. Prognostic impact of stone-scoring systems after percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 10 years. J Endourol, 30(2016), pp. 975-981.
[39]	J.P. Blandy, M. Singh. The case for a more aggressive approach to staghorn stones. J Urol, 115(1976), pp. 505-506.
[40]	J.M. Teichman, R.D. Long, J.C. Hulbert. Long-term renal fate and prognosis after staghorn calculus management. J Urol, 153(1995), pp. 1403-1407.
[41]	T.N. Morgan, M. Shahait, A. Maganty, M. Ost, S. Jackman, T. Averch , et al. Conservative management of staghorn calculi: when is it safe? J Endourol, 32(2018), pp. 541-545.
[42]	P.G. Deutsch, K. Subramonian. Conservative management of staghorn calculi: a single-center experience. BJU Int, 118(2016), pp. 444-450.